Routine Visit Procedures
By W. Karl Parker, B.A., D.C., F.I.C.C., F.A.C.C.
behapy@karlparkerseminars.com
Once the patient has been accepted for care and the first corrective
chiropractic adjustment has been administered, the patient is then
classified as a regular or routine patient. We will discuss many of
the aspects of regular visit procedures that continue to re-enforce
the all-important impressions that result in a life-long referring
patient. This article on regular patient procedures will describe the
usual procedures to follow on each visit with each patient.
These routine visit procedures are designed to improve service to
patients and to maximize the office's efficiency to better handle a
larger volume practice. These are the usual steps recommended to
take on each patient visit.
When the CA first greets the patient on each visit, the usual and
necessary social amenities should be performed. Be friendly and
sociable and show sincere interest in the patient. Be sure the
patient signs the sign-in register on each visit, always. When there
is a lull in the conversation and the CA feels the patient feels
properly acknowledged, ask the patient to be seated and then
physically turn your body and go back to whatever work you have to
do next.
This process could be as short as "Hi Mary, it's good to see you
again" with a similar quick response from the patient. It is not
necessary for the CA to engage the patient in conversation until it is
time to go to the adjustment room... and actually can be counter
productive, resulting in the dreaded "counter leaner syndrome."
The CA should use the 'What's better?" procedure on the first few
visits (about 10). By asking the patient "what's better?" you are
giving the patient the triple äAż (Attention, Acceptance, and
Approval), for being better People generally focus on what's hurting
and may not even realize they are actually much better Most
everyone in patients' environments are programmed to give them
sympathy for their discomforts. The CA, though, gets the patient to
focus on what's better, a more optimistic healing consciousness
concept. Sometimes this is not easy. You just have to gain and
maintain the patient's confidence by constant reassurance. I like to
say it this way... "Stand your ground, through all their frowns!"
CAs should use this concept instead of the usual "How are you?" at
least until patients are feeling great and your "What's better?"
programming procedure has caused them to openly express how well
they are doing. This is an excellent procedure to enhance the
patients' health improvement, as well as referrals for chiropractic.
The CA would then prepare the patient's records for utilization
during the visit. The paperwork can be placed in a clipboard or left
in a file folder and stacked to maintain patient order and can also be
hung on or by the adjustment room door or placed in a folder holder
attached to the wall or door. The patient's fee slip can also be
placed with the visit paperwork. The fee slip should at least note
the patient's name, account balance and the date and day of the next
scheduled appointment (remember, you made advanced appointments
with the patient in the beginning, very important!).
When a room is available, the patent can be told to proceed to the
designated room. The patient can be taught the procedure of taking
the clipboard or folder with him/her and placing the clipboard on the
treatment room door or the folder in the appropriate holder and
enter the room. The patient then follows the normal adjustment
preparation procedures taught to him/her on the first adjustment
visit. The patient would generally bring the clipboard (or folder)
back to front desk, after the visit.
The doctor should review the patient's file before entering the room.
Be sure to be aware of patients symptoms, in the beginning of care
and recently, as well as recall the last treatment procedures, be
aware of today╝s needs and determine the patient education needs
for this visit (to be discussed in detail in a later article). The
doctor then enters the room briskly, smiling and greets the patient
immediately with a handshake, if feasible (if patient is lying face
down, then a touch on the shoulder or upper back is appropriate). The
doctor╝s attitude is one of Loving Service, being sincere, attentive,
caring and showing concern for the patient's health.
The first thing to do after properly greeting patients is to check
them to see how their body is functioning and responding to previous
care. Some of the ways to do that is with kinesiological tests,
orthopedic tests, neurological tests, leg checks, and the old
standby... palpation and visual analysis. Use whatever monitoring
methods you have confidence in. Usually, the patient will volunteer
a response of how they are feeling, but if not, then ask AFTER or as
you are evaluating their spine, symptomatic areas or whatever
method of evaluation you do. This procedure lets patients know that
you are caring for their body based upon what's wrong with it, not by
how they feel.
I wish I could motivate all DCs to get this concept, own it and
transfer it to all chiropractic patients. This one step can make a
dramatic change in the growth and even the upbeat attitude of the
practice. Why? Because with this attitude you have become a
Doctor of Chronics, a health doctor, and have let go of being a Doctor
of Acutes, a symptom doctor, Remember this: If you focus on
symptoms, your patients are being taught by you that symptoms
equate to health and when patients' symptoms are gone ... so are
they! If you believe that symptoms are the criteria for determining
people's state of health, then I heartily recommend a series of KPS
seminars, in order to get some good old-fashion chiropractic KCBF!
Whenever DCs come to better own and implement this concept, their
practices go up commensurate to their level of understanding this
concept.
The DC should also ask the 'What's better?" question on the first few
visits. If a positive response is not forthcoming, then be more
specific about each symptom or use a pain measuring question, On a
scale of 1 to 10... etc.
After the visit evaluation is completed the DC should move right
into performing the health care needed on that visit. Be sure to
explain what you are doing, as you do it. This is the concept of
"Touch and Tell". Always be sure to touch (palpate) present and
previous symptom and cause areas, preferably before you adjust the
patient, again explaining the connection.
It is also an excellent procedure to follow up each adjustment with
a positive exclamation. Say words like "great", "wonderful",
"terrific" or at least "alright" or "OK". Be as gentle as possible and
still get the best correction possible. Be as specific as possible and
preferably only adjust the primary priority areas indicated by your
evaluation. If needed, use the analogy of what it is like to listen to
10 people trying to talk to you at the same time. You can't get
anything that╝s understandable. It's the same way with the body...
and doing too many things to the nervous system at once. Better
results can often be obtained by doing just the priority
adjustment(s).
It is also a good idea to talk as little as possible when giving
adjustments. This communicates to the patient that the adjustment
has great value and takes skill... and it does! A student once told me
that he had planned to become an orthopedic surgeon. He had the
opportunity to work with one who was famous for his knee surgery.
After observing the surgery only five times, the student felt that it
was so easy he could do it himself without the medical education.
This caused him to look for something with more meat to it... and he
found chiropractic. I asked him if he was able to learn to do an
adjustment in five tries. Uproarious laughter was his response.
It is best to not spend unnecessary time in the office visit with the
patient, even if you have it available to you. It's also a good idea to
keep a "touching contact with the patient as much as possible during
the actual treatment. There just isn't enough space to cover all the
reasons why I recommend these two points... just trust me, its
important!
One other thing the DC should do during each visit is to utilize a
concept I call PERCS (Patient Education and Referral Communication
System). Have an ongoing education program for your patients as
well as a referral motivation system. There are many ways to do
this and do something different on each visit. The Parker Way┼
system lays one all out for you, which will be discussed in a future
article.
At the end of the visit, complete the fee slip and confirm the next
scheduled appointment noted on the fee slip (assuming you have the
patient on advanced appointments. You can ask the patient to take
the file back to the Control Assistant (front desk CA) and go on to
your next patient.
The CA then makes the collection, completes any special
instructions or recommendations of the doctor told verbally to the
CA or noted on the fee slip or patient records, confirms the next
appointment, presents recommended pamphlets and then terminates
the visit with positive remarks, a smile and possibly even a
handshake.
Ahhh, a routine office visit nicely, efficiently and productively
conducted!